Amila S. Ratnayake, Dinesh Bagaria, April B. Llaneta, Ratrawee Pattanarattanamolee · 18 authors
Abstract Background Well-designed and functioning emergency medical service (EMS) can provide equitable access to emergency care to improve health issues, especially in low- and middle-income countries where the majority of deaths are due to conditions that could be treated with emergency care. To address this gap, this study explored the contextually appropriate development process in addition to the system architecture, which is lacking in Global South EMS research. Method This study was a thematic analysis of the development of EMS systems in six Asian countries. Experts in emergency care were selected through convenience sampling. Each country described and evaluated its EMS system using a standardized form with 102 EMS items that cover the emergency care system in terms of leadership, governance, financing, community-based activities, prehospital care, and quality assessment. From the descriptions, various themes were extracted focusing on the developmental perspective of EMS in Asia. Result The study identified the domain of the developmental focus, best practices, and future strategies for EMS in the Asian region. The identified areas for developmental focus are governance, multidisciplinary collaboration, communication/coordination, community participation, decentralization, equitable access, supply-demand balance, and quality assurance activities. Conclusion Countries under investigation achieved progress in planning, implementing, and sustaining EMS through varied strategies in the mentioned focal areas that can be emulated by other countries in this region. Further, their development levels varied according to the extent to which each country realized the development principles identified in this study.
Figure: emergency medicine, ACEP, AAEM, emergency physicians, American College of Emergency Physicians, American Academy of Emergency Medicine, CMGs, demographics, private equity, consolidationFigureEmergency physicians are strong-willed, smart, distractible, and accustomed to being in charge, but we're a bit like herding cats—challenging to unite. Nonetheless, our professional organizations are tasked with solving the problems of our specialty by uniting physicians with common goals. Understanding why physicians join or leave these organizations, specifically, why the physicians on the cusp are thinking of changing their membership status, is crucial to broadening organizational appeal and identifying unifying concerns. Physicians with strong opinions—positive or negative—about specific professional organizations are not likely to be on the cusp of changing membership status. Members and non-members on the margins, however, are potentially high-yield targets for gaining or retaining members. Recognizing the concerns of this group may be key to a professional organization's success. So, I decided to look at the American College of Emergency Physicians and the American Academy of Emergency Medicine. Importance of the Margin “This is exactly what the net promoter score is,” said Mollie Pillman, ACEP's senior vice president of membership engagement. “The theory behind it is that you have your promoters, your detractors, and your passives in the middle, and you really want to go after the passives because they're the ones whose minds you'll be able to change.” ACEP's Executive Director Sue Sedory agreed, noting that the margin is key for the specialty to stay strong. “If we can get more people who just want to engage and have a stake in the future of the specialty and then help them one by one, which is what our commitment has been, [that] is really key.” AAEM's president, Jonathan Jones, MD, said it's easy to attract people who already agree with you, but that he didn't want members just for members' sake. “What I do want is people that believe in our basic principles but have a different perspective, that have a different background, that have a different plan.” ACEP and AAEM said they recognize the need for a more granular understanding of marginal members and non-members, but neither engages in mathematical modeling of this problem. “We are about nine to 10 months into association analytics implementation, which is a platform built for associations that pulls in all of your data from events and from finance and from the membership database, and it consolidates all of it together,” Ms. Sedory said. “So hopefully we'll be able to answer that better in the future.” AAEM has yet to invest in such a system either, though it is something the academy has considered. Both organizations said they also recognize the importance of incorporating a diversity of opinions. “ACEP is taking proactive steps to integrate member and non-member feedback into its strategic planning process, evaluation of new offerings, and communication effectiveness,” the college said in a statement. “We regularly conduct focus groups which are carefully chosen to represent a wide range of demographics and perspectives, and test new ideas and benefits with diverse groups before they are made available to a wider audience.” Dr. Jones said AAEM strives not to become stuck in its own bubble by reaching out to physicians in academia, CMGs, and democratic groups. “If we have people from different practice environments, that's the best way that we can try not to become an echo chamber,” he said. “And obviously we want a diverse membership, not just from practice environments but geographically [and by] gender and race.” Proof of Concept I recently surveyed emergency physicians on Facebook about their thoughts on professional organizations. The total response number was low, just more than 100, which is not nearly high enough to generalize about emergency physician preferences. Selection bias was also a real concern with a smaller group acquired this way. My intent with these data was not generalization, however, but to demonstrate how a professional organization might assess their marginal members and non-members. If a group this size can be effectively segmented with a relatively small amount of data, then the same thing can be done more easily and effectively with larger sample sizes and larger amounts of data. I segmented the group based on a specific question: How much do you value membership in your professional organizations? I used k-medoids clustering (an unsupervised machine learning process that breaks data into k clusters by iteratively picking samples within data to serve as the cluster's best median, making it more robust to outliers than the similar k-means clustering process) to sort respondents into detractors (respondents who view the organization very poorly), promoters (respondents who view the organization very positively), and passives. I asked about the issues that professional organizations should prioritize more to see if there were differences of opinions based on the perceived value cluster allocation. These topics were selected based on feedback from interviewees and ACEP's latest annual report. Respondents had specific concerns (some different, some the same) about ACEP and AAEM that are more pressing for passives or marginal members than for other clusters. I ran a two-way ordinal analysis of variance testing of ACEP and AAEM clustering to confirm statistical significance on the (visible) differences. Marginal members of both organizations considered corporate consolidation and private equity in medicine to be an issue deserving of more attention.FigureI then flipped the tables and used only the respondents' age and their responses to the priority questions to determine how far apart respondents were using a metric called the Gower distance (to account for the ordinal data of the Likert scale). I chose to use three clusters (based on maximization of a metric called the silhouette width; this assesses the uniqueness of the clusters), and used a similar process to k-medoids clustering to form groups of respondents based only on what priorities they considered important, this time without knowledge of membership status or value. Clustering was able to sort respondents into groups that seemed to favor AAEM membership (cluster 1), favor ACEP membership (cluster 2), or eschew both organizations (cluster 3). Average perceived value of the organizations also followed this characterization. Cluster 1 valued AAEM membership the most and ACEP membership second, and the opposite was true for cluster 2. A United Specialty Both ACEP and AAEM report caring a great deal about members who may be on the margins; there are ways to find these members and determine what matters most to them. If organizations want to avoid becoming entrenched echo chambers, they must actively seek out marginal members and non-members and attempt to incorporate them in meaningful ways. A united specialty is clearly important, but marginal members do not want the same things as their nonmarginal counterparts; it is the responsibility of our professional societies to achieve real unity in critical areas by meaningfully incorporating the differences of opinion of others. There is likely a subset of physicians who is generally disenchanted, but ACEP's marginal population appears to be AAEM members and vice versa. This paints a hopeful picture in my mind: Reaching out and incorporating those with different ideas may be easier than we think. Even for emergency physicians. DR. BELANGER is the chief data officer of TotalCare (totalcare.us), the chair-elect of the American College of Emergency Physicians Workforce Section, and an emergency physician in McKinney, TX.
on behalf of the Neonatal Transport Study Group of the Italian Society of Neonatology (SIN), Maurizio Gente, Roberto Aufieri, Massimo Agosti · 8 authors
BACKGROUND: Despite regionalization of perinatal care provides for the "in utero" transfer of high-risk pregnancies, there will always be a number of neonates who undergo acute inter-facility transport. The presence of a well-organized Neonatal Emergency Transport Service (NETS) can prevent and reduce risks of transportation, especially for very preterm infants, and is therefore mandatory for any program of regionalization of perinatal care. Italian National Health System is highly decentralized and Regions are autonomous to structure, plan and delivery their regional health services. Consequently, organization models and resources available vary widely and significant regional differences in access and quality of health services have been reported in the past years. A national survey was conducted in 2015 by the neonatal transport study group of the Italian Society of Neonatology with the aim to describe neonatal transfer practices and to assess the Neonatal Emergency Transport Services (NETS) status in the 20 Italian regions. METHODS: A questionnaire regarding neonatal transfer practices and NETS activity for the previous year (2014) was sent to the 44 NETS operating in the 20 Italian regions. Demographic data were obtained from the Italian National Statistical Institute (ISTAT). RESULTS: The overall survey response rate was 100%. In 2014, only 12 (60%) of the 20 Italian regions were fully covered by NETS, 3 (15%) regions were partially covered, while neonatal transport was not available in 5 (25%) regions. Overall, in 2014, the 44 NETS operating in Italy transported a total of 6387 infants, including 522 (8.17%) having a gestational age < 28 weeks. CONCLUSIONS: The organization of NETS in Italy is devolved on a regional basis, resulting in a large heterogeneity of access and quality to services across the country. Where available, NETS are generally well-equipped and organized but limited volume of activities often cannot guarantee adequate levels of skills of personnel or an appropriate cost-efficiency ratio. The regions reported with lack of NETS have managed, or are trying, to fill the gap, but continuing efforts to reduce regional differences in the availability and quality of services are still needed.
А. К. Дулаев, V. A. Manukovskiy, D. I. Kutyanov, Yu. Yu. Bulakhtin · 6 authors
OBJECTIVE. The authors developed the management strategy of emergency care for patients with acute spinal surgical pathology in conditions of megapolis. MATERIAL AND METHODS. A comparative statistical analysis was made in 2627 patients. The patients (n =777) underwent treatment in multicenter hospitals of emergency care of the spine (decentralized system). The other patients (n = 1850) were treated in Municipal Center of Emergency Surgery of the Spine (centralized system). RESULTS. It is appropriate to establish departments of emergency surgery of the spine on the base of separate multicenter hospitals in megapolis. These hospitals should be properly equipped and they should have specially trained doctors and nurses, stable financing, effective management on admission to hospital. CONCLUSIONS. The efficacy of proposed measures allowed authors to recommend them to wide practical application.
Cardiac arrests claim millions of lives each year. The condition can often be treated with a de\nfibrillator,buttimeisaverycriticalfactor. Asaconsequence,survivalratesarelow.\nRecent developments in drone technology have made civilian drones both cheap, easy to\noperate, and reliable. This paper looks into opportunities to use drones to deliver defibrilla\ntors to cardiac arrest victims faster than an ambulance, and focuses on unifying the needs of\nemergencyresponsewiththerulesandregulationsrequiredtooperatethedronessafely.\nThe study is performed as a literature study combined with interviews. The primary stake\nholderswereidentifiedasemergencyresponseandtheCivilianAviationAuthority.\nThe results showed that there was both a perceived use for ambulance drones and a way to\nlegally use them. The suggested approach involves using ambulance drones at sporting events\nsuch as "Birkebeinerrennet" as a proof of concept, before more advanced or permanent pro\ngramsareconsidered.
BACKGROUND: Injury is the number one public health problem in Lithuania in terms of disability adjusted life years lost. The trauma system plays an important role in injury statistics. The objective of this article is to describe and assess the performance of Lithuanian trauma sector. METHODS: The framework for assessing the performance of health systems proposed by Murray and Frenk (2000) was employed. RESULTS: The primary intention criterion--to reduce the number of trauma cases, injury related mortality and disability rates by 30% by 2010-is well defined. The Lithuanian whole-trauma sector does not substantially contribute to improving the health of the population. The legitimate expectations of the community--respect of persons in terms of dignity, autonomy, confidentiality, client orientation--do not correspond with the responsiveness of the trauma service. Financing of the trauma sector does not correspond with the magnitude of the injury problem. Lithuanian trauma service is decentralized. There is no trauma leadership in the country. There is no national policy for unintentional injury prevention and control, no specialized injury research institute, no system of trauma centres, and no Injury Surveillance System in Lithuania. There is no such specialty as Emergency Medicine as of 2009. A political and public will to reform the trauma sector is not sound. CONCLUSION: The performance of the decentralized Lithuanian trauma sector does not match with the primary intention criterion and does not correspond to the needs of people. Lithuanian trauma service has to be conceptualized and changed to inclusive.
The Family Division of the High Court exercises jurisdiction in family proceedings in England and Wales. A broadly similar jurisdiction is exercised under the Children Act in care proceedings and in private law disputes between parents by county courts and family proceedings courts. It should be emphasised that this article is about civil, not criminal, proceedings in which the burden of proof is diVerent and the practice which I describe does not apply. 2 The most recent example is the acknowledgment by the Court of Appeal that paediatricians and child psychiatrists are entitled in family proceedings to express opinions on child abuse which are based on or take into account the expert's assessment of the child's truthfulness: see Re M and R (Child Abuse: Evidence) [1996] 2 FLR 195, CA. Equally, I do not have space to address the duties of experts generally, as to which there is agreement across all the divisions of the High Court that expert evidence presented to the court should be and should be seen to be the independent product of the expert uninfluenced as to form or content by the exigencies of litigation. In Re J [1991] FCR 191 at 226/7, Cazalet J said that in children's cases the duty to be objective and not to mislead is as vital as in any case, because the child's welfare is at stake, and his/her interests are paramount. He added that an absence of objectivity may result in a child being wrongly placed and thereby unnecessarily at risk. It must also be borne in mind that a misleading opinion from an expert may well inhibit a proper assessment of a particular case by the non-medical professional advisers and may also lead parties, and in particular parents, to false views and hopes. 3 By section 12 of the Administration of Justice Act 1960, as amended by Schedule 13, para 14 of the Children Act 1989, it is a contempt of court to publish information relating to proceedings brought (inter alia) under the Children Act. 4 Oxfordshire County Council v M [1994] Fam 151, CA: Re L (A Minor) (Police Investigation) [1996] 2 WLR 395, HL. 5 By section 1(2) the court is required to have regard to the general principle that any delay in determining questions relating to the upbringing of children is likely to prejudice their welfare. 6